Provider Demographics
NPI:1497058846
Name:PATRIOT EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:PATRIOT EMERGENCY MEDICAL SERVICE
Other - Org Name:LAWRENCE COUNTY EMERGENCY MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:740-532-2222
Mailing Address - Street 1:PO BOX 4434
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-4434
Mailing Address - Country:US
Mailing Address - Phone:740-532-2222
Mailing Address - Fax:740-532-4344
Practice Address - Street 1:2914 S 4TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2867
Practice Address - Country:US
Practice Address - Phone:740-532-2222
Practice Address - Fax:740-532-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4400223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2530756Medicaid
445015OtherOHIO AMBULETTE LICENSE
201031600168OtherOHIO SOS CERTIFICATE OF TRADE NAME
440022OtherOHIO EMERGENCY MEDICAL SERVICES LICENSE
02-1458000OtherOHIO BOARD OF PHARMACY
9348351Medicare PIN